title: Severe infectious complications following frontal sinus fracture: the impact of operative delay and perioperative antibiotic use.
abstract: BACKGROUND
  The purpose of this study was to investigate whether a delay in operative management of frontal sinus fractures is associated with increased risk of serious infections.
  
  
  METHODS
  Retrospective chart review was performed of 242 consecutive patients with surgically managed frontal sinus fractures who presented to the R Adams Cowley Shock Trauma Center between 1996 and 2011. Collected patient characteristics included demographics, surgical management, hospital course, and complications. All computed tomographic imaging was reviewed to evaluate involvement of the posterior table and nasofrontal outflow tract. Serious infections included meningitis, encephalitis, brain abscess, frontal sinus abscess, and osteomyelitis. Delayed operative interventions were defined as procedures performed more than 48 hours after admission. Adjusted relative risk estimates were obtained using multivariable regression.
  
  
  RESULTS
  There were 14 serious infections (5.8 percent). All patients with serious infections had both involvement of the posterior table and nasofrontal outflow tract injury. The cumulative incidence of serious infection in these patients was 10.8 percent. After adjustments for confounding, multivariable regression showed that operative delay beyond 48 hours was independently associated with a 4.03-fold (p < 0.05) increased risk for serious infection; external cerebrospinal fluid drainage catheter use and local soft-tissue infection conferred a 4.09-fold (p < 0.05) and 5.10-fold (p < 0.001) increased risk, respectively. Antibiotic use beyond 48 hours postoperatively was not associated with fewer infections.
  
  
  CONCLUSIONS
  Delay in operative management of frontal sinus fractures in patients requiring operative intervention is associated with an increased risk for serious infections. Continued antibiotic prophylaxis beyond the perioperative period provides little benefit in preventing serious infections.
  
  
  METHODS
  Risk, II.
authors.affiliation: Baltimore, Md. From the Johns Hopkins School of Medicine; the Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; and the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Bellamy
authors.forename: Josher
authors.initials: J
authors.lastname: Molendijk
authors.forename: Sashank K
authors.initials: SK
authors.lastname: Reddy
authors.forename: José M
authors.initials: JM
authors.lastname: Flores
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: Paul N
authors.initials: PN
authors.lastname: Manson
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents